For some, suicide prevention is an urgent priority. How do you approach it?

• Once the idea of suicide enters the mind as a possible escape from stress, it leads to high morbidity and mortality. On the other hand, many healthy young people commonly think of escape from life as an option, even fleetingly, during their high school years.

• It is unsolved enigma at the cross roads of how best to predict a completed suicide versus a quick whim of escape. This is because precursors vary wildly in the intensity of intent, not always sharing their inner thoughts, coupled with lack of maturity to size up events (or better said, over estimating the seriousness) leading to ending life. So, in my opinion, it may be best to screen and filter by asking questions, be vigilant and address it head on with any stress that is visibly impacting teens at each opportunity.

What are some scenarios that culminate in intention to end life?

• It is ultra-hard for teens where there is a culture in some high schools calling each other swear words openly in person or in face book, as gross as “whore” and “bitch.” They tell me it is very common, and there is constant spur of reactivity between friend groups and gets increasingly worse as family members get involved with reactivity vs. careful, thoughtful damage control. There may be a nidus of some naïve risk- taking behavior on the part of the teen that spurs perceived notoriety through fractured romanticized relationships. The shame and humiliation yields stress, layered by generalized anxiety, further layered on the top by major depression. These sediments of emotions deepen each time there is an open interaction or exposure at school each day. Rejection and being ostracized are the biggest factors. Refusing school, not wanting to face school after prolonged absence, shutting the inner pain through drugs become a vicious cycle.

• Another complicating scenario is where high school pressures mount in the presence of learning disorders or/and psychiatric disorders generating stress that skyrockets. Again, the anxiety and depression come in uninvited, often avoiding or refusing to go to school. The accumulating, hard to catch-up homework, slipping grades and exams towards college preparation create intense pressure all around. Feelings of hopelessness and helplessness become overwhelming.

• Intense personal vulnerability is also triggered by additional factors such as problems created by well-meaning parents caught up in their own struggles. It could be parental depression and anxiety, fighting between parents, drug abuse in the house-hold, lack of empathy or excessive identification becoming over-protective and so on. In some cases, there may be sexual abuse that is kept hidden, or friction over gender identity issues both at home and school. Even if there is no bullying at school or home, there is intense vulnerability and depression that can ensue in the transition process.

• If a young person is engaged in self-harm, at times it is to escape from pain as a release mechanism. They learn it from peers and become melodramatic in the process.

• The biological vulnerability of mental illness with no primary stressors or secondary stressors is very possible.

Are there certain indicators that raise alarm?

• Surely there are some clues such as having a psychiatric disorder, not telling anyone as they attempt suicide, leaving a note, repeated attempts that get more serious with each attempt and so on. But I like to underscore that this is not always the case. There may not be clues, and impulsivity may trigger serious attempt. Prediction is never 100% fail proof.

How do you actually begin addressing these risks?

• Remember the four Ss’! (1) Safety in removing all the pills, guns, ropes and toxic substances from the reach, (2) Supervision at all times, (3) Professional psychiatric/psychological Service (which may include medication), and (4) Stress reduction

What are the barriers?

• Lack of high quality help for both the teens and their parents can be a problem.
• Not being able to alter environmental stresses at school and among peers will slow down progress.
• Another problem is severe lack of inner strength with chronic suffering that requires a lot more resources and time to build it up.
• At times, in in patient or partial hospital programs, despite of high quality care from professionals, they may be exposed to other individuals with severe illness and maladaptive coping which may perpetuate helplessness.
• Remember that the teens will ruminate endlessly. Practicing coping skills to be mindful, or challenging negative thoughts may not be philosophically so easy, especially if they are not psychologically minded.

What are some encouraging thoughts for Teens?

• Listening (if they can open up which is a challenge at times), helping them problem solve and teaching them how to face life little by little are three anchors towards recovery. I would work at surpassing all the barriers mentioned above. They need to hear powerful lines like my story is mine, I live my life, I am the CEO of my life, no one can dictate my life, no one has power over me, I need to just live one hour at a time, focus on each day as a new day- a blank slate to live, find concrete ways to improve quality of life, writing down three things to do each day, be with supportive people, and not try too hard. It is not life if it is smooth all the time. They need to believe that universe will help them as life has a way of getting better. Hard times do not last forever. And that you will hold their hand till they feel better. Yes, there is light at the end of the tunnel.